Research has shown that:
- 70% of adults with a severe mental illness desire work.
- 60% or more of adults with mental illness can be successful at working when using supported employment.
What are the principles of supported employment?
Supported employment is based on six principles.
- Eligibility is based on consumer choice. No one is excluded who wants to participate.
- Supported employment is integrated with treatment. Employment specialists coordinate plans with the treatment team: the case manager, therapist, psychiatrist, etc.
- Competitive employment is the goal. The focus is community jobs anyone can apply for that pay at least minimum wage, including part-time and full-time jobs.
- Job search starts soon after a consumer expresses interest in working. There are no requirements for completing extensive pre-employment assessment and training, or intermediate work experiences (like prevocational work units, transitional employment, or sheltered workshops).
- Follow-along supports are continuous. Individualized supports to maintain employment continue as long as consumers want the assistance.
- Consumer preferences are important. Choices and decisions about work and support are individualized based on the person's preferences, strengths, experiences
Work is stressful. Will consumers experience increased symptoms if they obtain a competitive job?
Generally speaking, people who work do not experience symptoms at any higher rate than people who do not work. In fact, for many consumers, symptoms improve through the planned, purposeful activity of work. In supported employment, the assessment of an individual's strengths, coping strategies, and symptoms helps identify a good job and work environment for each person. It should also be remembered that not working is also stressful, often more stressful than working.
Case managers are already overworked. How will they have time to support this employment effort?
The work of employment specialists provides an additional resource for case managers and consumers in supporting consumer goals. Over time, consumers depend less on case managers and the mental health system as they progress in their recovery process.
How will colleagues be convinced that supported employment works?
Everyone will need education and training on how to carry out their part in supporting a consumer's efforts to work. Managers and supervisors help practitioners follow the principles and practices of supported employment in their daily work. More and more, practitioners who have seen how people grow when they are working have become convinced that work can be part of the recovery process.
The people I work with are too disabled to hold jobs. What does supported employment have to offer people with the most severe disabilities?
The evidence shows that even people with the most severe mental illnesses can work. In supported employment, job selection is tailored to individuals. An important part of the recovery process is hope. Supported employment provides all consumers a chance to succeed at employment. For some people, the opportunity to work a few hours a week is a symbol of hope.
If consumers start going to work, will they still be able to attend groups and activities and keep appointments with doctors and practitioners?
Agencies have restructured their resource allocations, programming, and scheduling as more consumers work. While most consumers are not taking full-time jobs, some may need evening appointments.
What is the role of psychiatrists in supported employment?
In supported employment, employment specialists work closely with the treatment team to support the goals of consumers. As clinical leaders, psychiatrists convey positive messages about work to consumers, family members, and the whole team. Psychiatrists make treatment recommendations based in part on how a person is functioning at work.
Limited resources are available to pay for needed case managers. Employment specialists seem like a luxury. How can an agency afford employment specialist positions?
Agencies continually make decisions about how to use their limited resources. As more consumers express a desire to work, providing supported employment is becoming an increasing priority. Leaders of numerous agencies and systems have established ways to fund supported employment programs. Some agencies, for example, have converted day program staff to employment specialists. In some states, the public mental health authority has worked out mechanisms with the Division of Vocational Rehabilitation and Medicaid office. Available financing mechanisms for such services vary from state to state and agency to agency.
How many employment specialists are needed for a program?
Employment specialists can manage caseloads of 20 to 25 people. While some case managers learn to support a consumer's work efforts, many consumers benefit most from employment specialists who are solely devoted to supported employment, in addition to their case managers.
How can we make time to talk about vocational issues when we have crises that need our attention?
Programs that have implemented evidence-based supported employment find that fewer crises occur because people are interested in developing their lives in the community and managing their illness more independently. Comprehensive and coordinated planning that occurs with supported employment leads to fewer crises, less chaos, and more structure.
What elements of supported employment are most critical?
Currently, some of the elements of supported employment have more supporting evidence than others. The following components are predictive of better employment outcomes:
- focus on competitive employment
- rapid job searches
- jobs tailored to individuals
- time-unlimited follow-along supports
- integration of supported employment and mental health services
- zero exclusion criteria (that is, no one is screened out because they are not ready)
How will we know which consumers are ready for supported employment?
Research has suggested that even people who are assumed unlikely to succeed in employment can improve their employment outcomes with the help of supported employment. When an agency develops a culture of work and encourages people to consider employment options, the number of people who go to work increases. Giving people the choice to decide whether or not to participate in supported employment is consistent with the recovery philosophy. Many consumers in agencies with supported employment programs identify themselves as wanting to work in competitive jobs.
Why should mental health agencies provide supported employment when consumers can access services at the Division of Vocational Rehabilitation?
The evidence shows that consumers achieve better employment outcomes with the support of programs that integrate employment support services and mental health treatment. Increasingly, mental health agencies are working closely with the Division of Vocational Rehabilitation to establish higher quality supported employment programs with demonstrated effectiveness for people with severe mental illness.